The candidate is a pediatrician committed to improving equity in childhood healthcare outcomes, especially for low-income children enrolled in Medicaid. Career development activities for the award period arise from three primary goals: 1) become a state-of-the-art child health services researcher; 2) establish a child health services research center; and, 3) increase national visibility for child health services research in high-risk, vulnerable children. The career development plan uses adult learning theory as a basis for designing and implementing specific objectives for each goal. Plans for achieving each objective include formal instruction, interaction with collaborators, practical applications, and self-evaluation and feedback. An advisory group of internal and external senior faculty will meet semi-annually with the candidate to provide feedback and guidance on progress towards stated goals and objectives. The aim of the candidate's research proposal is to examine the effect of Medicaid managed care organizations (MCOs) on access to specific recommended care for children with asthma, as individual MCOs may have conflicting incentives for authorizing care or providing resources for care. The study will compare MCO's with respect to suboptimal use of preventive medications for asthma among approximately 24,000 children with moderate to severe asthma in Washington State and Tennessee. The study will be conducted using a Medicaid research database, linked with vital records and U.S. Census data in Washington State and Tennessee. Additional studies will apply new research methodologies and will be directed at augmenting study findings by addressing recognized limitations of the proposed studies. These evaluations will increase understanding of inequities in care for children and will allow for future interventions to reduce disparities for vulnerable children.